What Does An Endocrinologist Do On The First Visit

Many people think that the best doctor to treat every thyroid condition is an endocrinologist.
Endocrinology is the specialty that offers advanced training in the endocrine system—which includes various glands and organs such as the thyroid, pancreas, ovaries, testes, and adrenal glands, among others. The majority of endocrinologists specialize in diabetes treatment. More recently, an increasing number are specializing in the profitable area of reproductive endocrinology (also known as "fertility doctors.

") With an aging population, endocrinologists are also increasingly being called on to help manage osteoporosis.
Surprisingly, despite the prevalence of thyroid disease, few endocrinologists choose to focus their work on thyroid diagnosis and treatment. Those who do work with thyroid patients tend to concentrate mainly on handling more acute thyroid situations such as thyroid cancer, thyroid storm, and Graves' disease.

A small subset of endocrinologists want to differentiate themselves, and refer to themselves as "thyroidologists." Thyroidologists tend to be very traditional endocrinologists.
If you have a suspected or diagnosed thyroid condition, do you need an endocrinologist? The answer: many thyroid patients do not need an endocrinologist. It sounds counterintuitive to say this, but in some cases, an endocrinologist or thyroidologist may not even be your best choice.

When should you absolutely use an endocrinologist?
First, if you have thyroid cancer, you should see an endocrinologist. Keep in mind that you can't just pick any endocrinologist off a list.
You only want one who has expertise in treating thyroid cancer patients. Since thyroid cancer is not especially common—an estimated 50,000 cases a year are diagnosed in the U.S.—many endocrinologists may never have even diagnosed or treated thyroid cancer.

(A good source to find physicians who specialize in diagnosing and treating thyroid cancer is the Thyroid Cancer Survivors' Association).
Second, if you have acute Graves' disease, thyroid nodules, or a goiter, see an endocrinologist. But again, you will need an endocrinologist who has specific expertise in treating thyroid patients. You do not want a diabetes specialist who handles a thyroid patient here and there on the side.

The American Thyroid Association "Find a Specialist" directory or the endocrinologists listed in the Thyroid Top Docs Directory are a good resource.
Third, if you are pregnant and you have a thyroid condition, or you have a newborn or young child diagnosed with a thyroid disorder, see an endocrinologist. It's especially important to manage your thyroid during pregnancy, because poor treatment can endanger your pregnancy and result in problems for the newborn.

And managing thyroid issues in newborns and young children is better handled by an endocrinologist and not something that should typically be left to a pediatrician.
What kind of doctor should do thyroid surgery?
When you need to have surgery to remove all or part of your thyroid, choose a surgeon who is an expert in thyroid surgery. Keep in mind that many ear/nose/throat and general surgeons are not considered thyroid surgery experts; and you'll want a surgeon who does dozens of thyroid surgeries a year, at minimum.

For more information, read Finding a Top Thyroid Surgeon.)
When should you consider a doctor beyond an endocrinologist?
If you have a "harder to diagnose" thyroid imbalance, autoimmune thyroid disease like Hashimoto's, subclinical/borderline thyroid disease, a "normal" TSH but thyroid symptoms, or you're being treated for hypothyroidism but you still don't feel well, most endocrinologists are probably not the best fit for you.

Why?
There are several reasons. First, we have a severe and worsening nationwide shortage of endocrinologists, so it isn't even easy to get in to see a qualified endocrinologist.
Right now, there are an estimated 4,000 endocrinologists in the United States who are serving as many as 100 million Americans—with diabetes, fertility problems, polycystic ovary syndrome, osteoporosis, Graves' disease, thyroid cancer, thyroid nodules, etc.

—who realistically should be seen by an endocrinologist. That's one endocrinologist for every 25,000 people who need one. And, only 150 or so new endocrinologists are coming out of specialty training each year.
Second, given such a shortage, most endocrinologists can't do time-consuming detective work, or trial-and-error treatment protocols, with patients who do not have what the doctors consider to be a "life-threatening" thyroid conditions.

That means that patients who have conditions like Hashimoto's, or who are being treated for hypothyroidism but still experiencing symptoms, are often considered to be very lower priority by endocrinologists. (This is not to say that Hashimoto's and hypothyroidism are not debilitating and worthy of serious attention. Endocrinologists, however, do not consider them to be acute, high-level, or life-threatening thyroid conditions.

Given the lengthy waiting lists of patients with diabetes and acute thyroid problems, some endocrinologists have said outright that Hashimoto's and hypothyroidism don't warrant a specialist.)
Third, access is also a major consideration. You'll often have to wait months to get an appointment with an endocrinologist. Even then, your appointment is likely to last only a few minutes. (In some cases, you may be seen by a physician's assistant, and never see the endocrinologist personally.

) If you do get to see the doctor directly, some endocrinologists may act as if you are "wasting their time" if you are coming to them with borderline thyroid test levels, or a "normal" TSH test but continuing symptoms. Most endocrinologists tend to strictly follow the official treatment approaches of their professional organizations, so you are likely to be diagnosed and treated according to the treatment guidelines of, for example, the American Association of Clinical Endocrinologists (AACE).

The AACE guidelines say that keeping the thyroid in balance requires what they say are "three easy steps:" (1) testing using the TSH test, (2) prescribing levothyroxine so the patient is in the "normal range" and (3) following up with a TSH test every 6 to 12 months. The majority of endocrinologists are not comfortable supplementing levothyroxine medications with prescription T3 drugs, despite some studies that suggest a benefit for some patients.

And most endocrinologists do not prescribe natural desiccated thyroid drugs like Armour or Nature-throid.
What are the two types of thyroid specialists?
Thyroid patients and the thyroid community are starting to recognize that in practice, thyroid disease may actually require two very different types of "specialists:"
The "specialists" for hormone balance and chronic hypothyroidism tend to be found in a variety of disciplines and specialties, and include:
integrative physicians
functional medicine doctors
holistic MDs
osteopathic physicians
naturopathic physicians
anti-aging practitioners
gynecologists
menopause and bioidentical hormone experts
internists and primary care physicians who have taken an interest in thyroid and hormone balance in their patients.

When should you consider changing doctors?
There are endocrinologists who believe in giving Hashimoto's disease and hypothyroid patients in-depth and comprehensive attention and care. If you are under the care of a compassionate and effective endocrinologist, continue doing what works.
However, if you are seeing an endocrinologist and are frustrated at what you feel are limitations in the diagnostic and treatment approach, you may need help considering another type of doctor.

Read How Thyroid Patients Can Find the Right Kind of Doctor for Their Thyroid Care for more information.
A Word from Verywell
The decision to find a new doctor for your thyroid care is actually more difficult than most of us might think. The relationship with a doctor is an intensely personal one, and it's not easy to find the right match, particularly when we're limited by geography, HMOs and insurance.

Remember that in a doctor-patient relationship, YOU are the client, and the doctor is providing a service. And if that service is not meeting your needs, the best thing you can do for your thyroid health is to find the right doctor who will meet your needs. But how do you know when it's finally time for a new thyroid doctor? Here are 10 Signs That You Need a New Thyroid Doctor.
Source:
Lash, Robert, MD.

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Endocrinologists are doctors who specialize in glands and the hormones they make. They deal with metabolism, or all the biochemical processes that make your body work, including how your body changes food into energy and how it grows.
They may work with adults or kids. When they specialize in treating children, they're called pediatric endocrinologists.
What Do Endocrinologists Do?
They cover a lot of ground, diagnosing and treating conditions that affect your:
Adrenals, glands that sit on top of your kidneys and help to control things like your blood pressure, metabolism, stress response, and sex hormones
Bone metabolism, like osteoporosis
Cholesterol
Hypothalamus, the part of your brain that controls body temperature, hunger, and thirst
Pancreas, which makes insulin and other substances for digestion
Parathyroids, small glands in your neck that control the calcium in your blood
Pituitary, a pea-sized gland at the base of your brain that keeps your hormones balanced
Reproductive glands (gonads): ovaries in women, testes in men
Thyroid, a butterfly-shaped gland in your neck that controls your metabolism, energy, and brain growth and development
Training
Endocrinologists are licensed internal medicine doctors who have passed an additional certification exam.

They go to college for 4 years, then medical school for 4 more years. Afterward, they work in hospitals and clinics as residents for 3 years to get experience treating people. They'll spend another 2 or 3 years training specifically in endocrinology.
The whole process usually takes at least 10 years.
Where to Find One
An endocrinologist can work in:
A medical practice with other endocrinologists
A group with different kinds of doctors
Hospitals
You can search for one on the American Association of Clinical Endocrinologists website.

Some don't see patients. They may work in universities or medical schools, where they teach medical students and residents or do research.
When to See an Endocrinologist for Diabetes
Your regular doctor can treat diabetes, but they might refer you to an endocrinologist when:
You're brand new to diabetes and need to learn how to manage it.
They don't have a lot of experience treating diabetes.
You take a lot of shots or use an insulin pump.

Your diabetes has gotten tough to manage, or your treatment isn't working.
You have complications from diabetes.
You can always ask to go to an endocrinologist, too, even though your doctor doesn't suggest it first. When you see one, you'll still need to visit your primary doctor as well. They'll work together.
Continued
Appointments With Your Diabetes Doctor
Your endocrinologist will ask you about how you feel, what you're doing to manage your diabetes, and any trouble you're having.

Take your blood glucose journal or logs with you, and let your endocrinologist know what's been going on with you. What's changed since the last time you saw them?
Symptoms
Eating differently
Working out more or less
Been sick lately
Started taking any medicines, vitamins, or supplements
Chances are they'll want to check your blood pressure and your feet and test your blood glucose, urine, and cholesterol.

If you take insulin, you should probably see your diabetes doctor every 3 or 4 months. Otherwise, you can go a little longer between visits, every 4 to 6 months. You may have to go more often when your diabetes isn't under control, you have complications, or you have new symptoms or they get worse.
Sources
SOURCES:
American College of Physicians: "Endocrinology, Diabetes, and Metabolism."
Hormone Health Network: "Fact Sheet: Adrenal Incidentaloma," "What Is an Endocrinologist?" "Value of an Endocrinologist.

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